Rate reviews allow consumers to oversee health insurance increases

Ask Arizonans about their health care concerns and — overwhelmingly — they will say they are worried about how much their health insurance costs and whether they will continue to be able to afford it.

Although there are many reasons for the unsustainable rise in the cost of health care coverage (including the continual rise in health care costs), one important factor is that consumers often lack the information they need to make informed decisions about what plans are right for them. Few individuals or small businesses know how much of their premium dollar goes to health care versus administrative costs like paperwork, staff salaries and profits. Consumers also have a hard time discovering why their premiums are going up.

While there is no ace in the hole for solving these problems, Arizona does have options to increase transparency so consumers have better information and are better protected against unreasonable rate increases. One important opportunity is through a process called rate review, which can potentially empower consumers by requiring insurers to make information on why rates are increasing publically available.

Rate review offers a way for states to oversee insurers’ premium increases and provide better consumer protections. States generally adopt one or more of three strategies to strengthen their rate review

processes: increasing the transparency of insurers’ stated reasons for increasing rates; having regulators evaluate whether the proposed increases are reasonable; and requiring insurers to get approval before they raise premiums. These approaches are not mutually exclusive. In fact, states with the strongest rate review programs include all three. The track record of states that have adopted strong rate review processes shows that such processes meet a real need and deliver results for consumers.

While there are many reasons why insurers may be justified in raising health insurance rates, insurers sometimes engage in unscrupulous rate- setting practices that leave consumers paying an unfair premium. There are several ways a rate can be unreasonable: for example, it can be unjustified because the rate increase is not adequately supported by the data; or it can be based on unfair or incorrect rate-setting practices.

To protect consumers from unjustified rating practices and ensure that consumers pay a fair premium for their coverage, Arizona should take the following steps to strengthen its rate review process:

Review and prior approval: Arizona should make its rate review process more effective in protecting consumers by strengthening the Arizona Department of Insurance’s authority to prevent unreasonable rate increases from going into effect. Most consumers are ill-equipped to determine on their own whether premium increases are unreasonable or detect when insurers have used unjustified rate-setting practices.

More than 30 other states already have prior approval authority for at least some insurance products, including other Western states like New Mexico, Nevada and Colorado.

Improve transparency: For all proposed rate increases or decreases, insurers should be required to file a full range of information with the Arizona Department of Insurance. In turn, the department should make this information publicly accessible, allowing consumers to make judgments about the quality and cost of their care, and enabling advocates to more constructively engage in the department’s rate review activities. Disclosure should include a short narrative (written in consumer-friendly language), including key reasons for the rate increase. It should also include information on the expected impact of the rate increase on consumers, the anticipated medical trend, level of administrative spending and profit margin, and full claims data and methodology details supporting these estimates.

Consumers should also be informed of any rate increases that have been deemed to be unjustified.

Involve consumers: Robust consumer participation can make a rate review program more useful to the public, and render regulatory deliberations better-informed. The Arizona Department of Insurance should post all rate increase information on a prominent and easy-to- use website in order for consumers to research rate filings. The department should also develop easy ways for consumers to comment on pending filings and hold public hearings on rate filings that it determines are significant due to the size of the proposed increase, the scope of any proposed benefit changes and the number of consumers affected.

By making these changes, Arizona could make insurance coverage more affordable by providing consumers with needed information and protections. More transparency and enhanced consumer protections could allow for a more competitive insurance marketplace, resulting in lower health insurance costs and improving coverage for individuals and small businesses in our state.

— Fred Karnas is president and CEO for St. Luke’s Health Initiatives. Diane E. Brown is executive director of Arizona PIRG Education Fund.

2 comments

“Robust consumer involvement and added protections” would be a vast improvement here in Arizona. How far would it extend? The “client”is not the health consumer, even if the health consumer pays 50% of the bill. The insurance companies and the health providers leave the consumer most often completely out of the loop by design. Often they employ methods citing privileged data. An example this past year:

I called the AZ Dept of Insurance to find out whether they were going to approve a 70% rate increase requested by my Long Term Care Insurance PLan Provider as press sources reported; and I asked if the AZ Insurance Dept had already approved the increase,would they provide me with the reasons and hard data that backed up the change. I was worried about financial stability.
I was greeted by an unfriendly & annoyed Ins Dept. employee, told plainly that theAZ Dept of Insurance served the Insurance Companies, solicit no public input, and did not have to provide any of their decisions to the public or reasonable data to back up the reasons for rate increases. They cited “privileged information.”
So 30 states have transparency, but apparently the health “industry” successfully blocks that here in Arizona due to a Legislature with many members from Industry.